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MDH case mix classification system experiencing difficulties


Todd Bergstrom
By Todd Bergstrom  |  October 18, 2019  |  SNF/NF providers



The Minnesota Department of Health (MDH) computer program that generates the Medicaid case mix classification (or RUG level) to be used by the Minnesota Department of Human Services (DHS) for Medicaid payment, as well as populate resident classification letter, is experiencing technical difficulties.

Note the Minnesota Department of Health (MDH) is successfully accepting the Minimum Data Set (MDS) files transmitted by nursing facilities. The issue lies within the MDH “RUG Calculator.” MDH is first working to assure the accuracy of the RUG classifications that are generated and sent over to DHS for payment to nursing facilities.

According to MDH communication:
The October 1, 2019, updates by CMS have impacted the MDH Case Mix Review Program. Please share this information with facility administrator, MDS coordinator, CMR portal users, and other facility staff as needed.
  • Due to the software updates by the Centers for Medicare & Medicaid Services (CMS), MDH case mix review will NOT PENALIZE OBRA assessments submitted and accepted by QIES ASAP from October1, 2019, through October 31, 2019
  • RUGs calculations: Some of the OBRA assessments submitted to QIES ASAP and copied by MDH case mix review are not calculating a RUG classification (i.e. Medicaid RUG-IV 48 Grouper)
    • These assessments will appear in Section 2 on the case mix validation report
    • No action is required by facility staff
    • MDH case mix review has a plan and will share RUGS classification and effective dates with the DHS for Medicaid payments
    • MDH case mix review IT staff are working on this issue and expect to resolve by the week of October 21
  • Minnesota statute requires the nursing facility to distribute the “notice of resident reimbursement classification” within three business days of receipt of the notices (not three days from when the notices were expected to be in the MDH case mix review portal).

Please contact Todd Bergstrom at the Association office if you have any questions.




Todd Bergstrom  |  Director of Research & Data Analysis  |   tbergstrom@careproviders.org  |  952-851-2486




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